ER9 Incident Report Form 2018-2019
As members of the Easton, Redding, and Joel Barlow communities we make it a priority to care for ourselves, our community, and our world. If you have any information that can be used to keep a classmate, friend, or community member safe from mean behaviors, self-harm, and/or drug involvement, please fill out this form. Complete the prompts that apply to the situation. Leave the others blank.
Name (optional) All anonymous complaints will be investigated. However, please note that no disciplinary action shall be taken solely on the basis of an anonymous complaint.
Your answer
Email address (optional):
Your answer
Role of the person making the report (student, parent, teacher, etc.):
Your answer
The name of the student who is experiencing or is the target of mean or harmful behavior(s): *
Your answer
The name of the student being reported as committing the mean or harmful act: *
Your answer
Date, time, and place of the mean/unsafe behavior(s): *
Your answer
Description of the incident: *
Your answer
Name(s) of witness(es):
Your answer
Any additional information that you think will help us understand the incident:
Your answer
Select the School Climate Specialist who will be responding to this incident: *
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